Journal of frailty, sarcopenia and falls最新文献

Objectives: To determine the effects of hospitalisation upon frailty and sarcopenia.

Methods: Prospective cohort study at single UK hospital including adults ≥70 years-old admitted for elective colorectal surgery, emergency abdominal surgery, or acute infections. Serial assessments for frailty (Fried, Frailty Index, Clinical Frailty Scale [CFS]), and sarcopenia (handgrip strength, ultrasound quadriceps and/or bioelectrical impedance analysis, and gait speed and/or Short Physical Performance Battery) were conducted at baseline, 7 days post-admission/post-operatively, and 13 weeks post-admission/post-operatively.

Results: Eighty participants were included (mean age 79.2, 38.8% females). Frailty prevalence by all criteria at baseline was higher among medical compared to surgical participants. Median and estimated marginal CFS values and Fried frailty prevalence increased after 7 days, with rates returning towards baseline at 13 weeks. Sarcopenia incidence amongst those who did not have sarcopenia at baseline was 20.0%. However, some participants demonstrated improvements in sarcopenia status, and overall sarcopenia prevalence did not change. There was significant overlap between diagnoses with 37.3% meeting criteria for all four diagnoses at 7 days.

Conclusions: Induced frailty and acute sarcopenia are overlapping conditions affecting older adults during hospitalisation. Rates of frailty returned towards baseline at 13 weeks, suggesting that induced frailty is reversible.

Objectives: The purpose of this study was to develop a questionnaire that can reliably recognize Greek individuals over the age of 60 with increased risk of falls.

Methods: An 11-item self-reported Questionnaire (LRMS) was developed and delivered to 200 individuals. Collected data were compared to Timed Up and Go (TUG), Falls Efficacy Scale-International (FES-I), Tinetti Assessment Tool, Geriatric Depression Scale-15 (GDS-15) and Morse fall scale. The results were statistically analyzed.

Results: Correlation between LRMS and the examined tools was high TUG (r=0.831), FES-I (r=-0.820), Tinetti balance (r=-0.812), Tinetti gait (r=-0.789), GDS-15 (r=-0.562), and Morse fall scale (r=0.795). Cronbach's alpha for LRMS total score was 0.807. ICC of the LRMS total score was 0.991. The area under the curve of LRMS was 0.930 (cut-off point 10.5, 95% C.I. 0.88 - 0.98, p<0.001, sensitivity=86%, specificity=98%) with TUG as gold standard, 0.919 (cut-off point 11.5, 95% C.I. 0.88 - 0.96, p<0.001, sensitivity=85%, specificity=89%) with FES-I and 0.947 (cut-off point 10.5, 95% C.I. 0.91 - 0.98, p<0.001, sensitivity=93%, specificity=91%) with Tinetti.

Conclusions: The LRMS Questionnaire showed sufficient internal consistency, excellent test-retest reliability and high correlation with the already established tools for fall risk assessment. It is short and easy to use without assistance from specially trained personnel.

Objectives: This study aims to evaluate the effect of frailty in patients undergoing radical cystectomy (RC) for locally advanced bladder cancer.

Methods: In this retrospective, single center study we evaluated 51 patients with pT4 bladder cancer treated with radical cystectomy between 2016-2020. Patient frailty was assessed with the Clinical Frailty Scale (CFS). Furthermore, six separate parameters (early mortality index within 30 days after surgery, death after one year, length of stay, respiratory complications, readmission index, total hospital charges) were also evaluated. The patients were categorized on three groups (Group 1, 2, 3) based on the CFS.

Results: A total of 51 pT4 RC patients were included in the study. Mean age was 75.6 years. Early mortality rate at 30 days after surgery was low all the groups. One year mortality rate was higher in Group 2 (22%) and 3 (69%). The length of stay and the number of patients with respiratory complications were also higher in the frailer groups. 30 days readmission rate was 22% in Group 2 and 38% in Group 3.

Conclusions: Preoperative frailty is associated with worse postoperative results after RC. CFS is an objective tool for patient risk stratification and can predict postoperative complications and mortality.

Trial literature on falls management in care homes may provide limited detail on current practice and instead this information may be found in grey literature. This scoping review aimed to identify the key characteristics of current falls management programmes for UK care homes identified from the grey literature. A scoping review was conducted and evidence sources were included if they were targeted at UK care homes for older people and included any component of falls management (assessment, intervention, training). Search activities included searches of electronic databases, professional websites and contacting care homes for current examples. The principles of intervention component analysis were conducted to describe the features of falls management. Forty-eight evidence sources were included (17 online resources, 10 online articles, 9 policies and standards and 12 examples provided by individual care homes). 67 themes were identified under eight domains. The core domains detailed the characteristics of Assessment, Interventions and Training. The approach taken to managing falls was an overarching domain, with supporting domains including how to report and monitor falls, when to complete assessments and interventions, governance and accountability, and involvement of the wider healthcare system.

Objective: Identify contributors to differences in the muscle size and strength of sedentary and active young and middle-aged adults.

Methods: This cross-sectional study included 98 participants aged 20-65 years. Participants were categorized based on age and self-reported physical activity (PA) habits. Participants completed a strength assessment of knee extensors (KEPT), knee flexors (KFPT), plantar flexors (PFPT), and dorsiflexors (DFPT), a 3-day dietary intake log, 7-day accelerometry, and a magnetic resonance imaging (MRI) scan for muscle cross-sectional area analysis of the right quadriceps (CSAq).

Results: There were significant age and activity-related group effects for relative protein intake (p<0.001), relative energy intake (p=0.04), KEPT (p=0.01), CSAq (p=0.002), PFPT (p=0.004) and DFPT (p=0.003). Moderate, moderate-to-vigorous, and vigorous PA were positively associated with CSAq (R²=0.69- 0.71; p<0.05), KEPT (R²=0.61-0.63; p<0.05), and PFPT (R²=0.31-0.36; p<0.05). Relative protein intake and daily leucine intake were significantly and positively associated with CSAq (R²=0.70 and 0.67 respectively; p<0.05), KEPT (R²=0.62 and 0.65 respectively; p<0.05), and PFPT (R²=0.29 and 0.28 respectively; p<0.05).

Conclusion: Muscle size and strength were lower in middle age relative to younger age, but increased PA, protein intake, and leucine intake was associated with the preservation of muscle size and strength in larger muscle groups of the lower body.

Objectives: Sarcopenia is postulated to be an influential factor in chronic low back pain. The aim of this study is to evaluate the relationship between traditional clinical measures of sarcopenia and novel radiographic methods which evaluate overall muscle status, such as adjusted psoas cross-sectional area (APCSA) and degree of fat infiltration (%FI) in paraspinal muscles, in patients with chronic low back pain.

Methods: Prospective study performed at our institution from 01/01/19-01/04/19. Inclusion criteria were patients ≥65 years old not requiring surgical intervention presenting to a low back pain assessment clinic.

Results: 25 patients were identified (mean age: 73 years, 62% male). On spearman's analyses, %FI shared a significant relationship with hand grip strength (r = -0.37; p=0.03), chair rise (r=0.38; p=0.03), SC (r=0.64; p<0.01), and visual analogue scale scores (r=-0.14; p=0.02). Comparably, a statistically significant correlation was evident between APCSA and %FI (r=-0.40; p=0.02) on analysis.

Conclusion: The results of our study demonstrate a statistically significant relationship between APCSA and %FI in the multifidus and erector spinae muscles. Further significant associations of relatability were depicted with traditional clinical measures of sarcopenia. Thus, %FI may be a supplemental indicator of the sarcopenic status of patients presenting with chronic low back pain.

Objectives: The objective was to determine odds of frailty syndrome with coexistence of hypertension and depression among oldest-old adults.

Methods: We analysed secondary data from 167 community-dwelling hypertensive participants aged 80 years and older from a cross-sectional study of frailty conducted in India. Data included sociodemographic, medical history, physical performance, functional limitations, mobility-disability, cognition, depression, sleep, frailty syndrome and chronic diseases. Odds of frailty syndrome was compared among individuals having only hypertension, and individuals having hypertension and depression. Chi-square test, t-test and logistic regression were performed to determine odds of frailty.

Results: Frailty was significantly higher (OR: 4.93;95% CI: 1.89-12.84) among individuals having hypertension and coexisting depression, compared to individuals having only hypertension. Men (OR: 5.07;95% CI: 1.02-25.17) and women (OR: 4.58;95% CI: 1.36-15.40) with hypertension and depression showed a higher risk of frailty, compared with hypertension alone. Logistic regression models were adjusted for age, sex, cognitive impairment, chronic obstructive pulmonary disease, cardiovascular diseases, anaemia, diabetes, obesity, physical performance, activities of daily living and 4-meter walking speed.

Conclusion: Coexistence of hypertension and depression increased risk of frailty syndrome among men and women above 80 years of age by almost 5 folds. Treating depression in hypertensive older individuals may reduce the risk of frailty among them.

We evaluated predictors of the Clinical Frailty Scale (CFS) scored by an interdisciplinary team (Home FIRsT) performing comprehensive geriatric assessment (CGA) in our Emergency Department (ED). This was a retrospective observational study (service evaluation) utilising ED-based CGA data routinely collected by Home FIRsT between January and October 2020. A linear regression model was computed to establish independent predictors of CFS. This was complemented by a classification and regression tree (CRT) to evaluate the main predictors. There were 799 Home FIRsT episodes, of which 740 were unique patients. The CFS was scored on 658 (89%) (median 4, range 1-8; mean age 81 years, 61% women). Independent predictors of higher CFS were older age (p<0.001), history of dementia (p<0.001), mobility (p≤0.007), disability (p<0.001), and higher acuity of illness (p=0.009). Disability and mobility were the main classifiers in the CRT. Results suggest appropriate CFS scoring informed by functional baseline.